Immunization audits for school and child care presentation — original pdf

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Immunizations Unit School / Child Care Assessments and Compliance Rayna Edgar Hurtado, Supervisor Margaret Monreal, Medical Regulatory Monitor Raquel Acosta, Patient Representative Rayna Goransson, Community Worker Selection & Purpose The Texas Department of State Health Services (DSHS), Assessment, Compliance and Evaluation Group, randomly selects 20% of the licensed child-care centers and registered/licensed childcare homes in the regional area for a detailed immunization audit. Selection & Purpose On behalf of DSHS, the immunization audit team at Austin Public Health is tasked with conducting immunization compliance audits of the selected facilities in Travis County. 100% of the immunization records for each facility are audited to measure compliance with state immunization requirements. Compliance or non-compliance is reported to the Texas Health and Human Services Commission (HHSC) Childcare Licensing Division as part of an agreement between DSHS and HHSC to eliminate duplicative inspections of childcare facilities (HB 1555 of the 75th legislature). Audit Preparation Upon receipt of the audit list from DSHS: • Contact facility to inform of selection, provide audit overview & audit options (on site/in-office) audit • Verify point of contact, enrollment count, age range of enrolled children, notification preference & ImmTrac the Texas Immunization Registry, a database with immunization records for Texas residents. • Send official Intent to Audit letter via email/mail with current Texas Minimum State Vaccine Requirements. Facilities are given a deadline to respond to the letter. Audit Preparation Once facility responds to the letter: • Explain the audit process, answer questions and set the audit appointment date • Discuss audit options (on site/in-office), documents needed and how documents will be sent (fax/mail) • Discuss immunization record validation requirements • Set a timeline for receipt of documents prior to the audit • Email confirmation of appointment with additional resources. Day of Audit Record review: Acceptable vaccination records include those from State Immunization Registries, physician offices, or personal health records and must include: • Date of birth • Vaccination dates for each vaccine received (month, day & year) • Validation of record to include the signature, initials or stamp of the physician or physician’s designee or public health personnel for each vaccine on handwritten records • Clinic/physician contact information and provider’s signature/stamp for immunization records generated from electronic health record systems. Valid (unexpired) State of Texas Exemption from Immunizations for Reasons of Conscience or a valid Medical Exemption document. 2024-2025 Texas Minimum State Vaccine Requirements Recommended and Catch-Up Immunization Schedules Audit Results An immunization record that is missing doses in any vaccine category or that does not meet the state requirement for a valid record is considered non-compliant (delinquent). At the end of the audit, non- compliant doses are balanced with the enrollment count and percentages are calculated for each vaccine category. The audit then goes through a quality assurance (QA) process for a second review. Audit Results Compliant (> 95%): • Close out audit, call the facility with results, mail/email letter of compliance to facility & childcare licensing. • Provide the facility a list of non-compliant records (if any) • Enter audit data in the electronic Child Health Reporting System (CHRS) and email report to the DSHS representative. Audit Results Non-Compliant (< 95%): • Prepare and provide a letter requesting updated records. The State allows 30 days for the facility to make corrections to our findings. •Provide a list of delinquent records and what is needed for the record to be compliant •Provide a notice directed to the parent of non-compliant children regarding the immunization audit and findings specific to their child. • An immunization resource packet is provided including the required and recommended schedules • A follow up audit in 30 days (2nd visit audit) to review updated records. Audit Results 2nd visit Audit: • Contact facility after 10 days of audit to confirm receipt of packet (if mailed). • Contact again 10 days before deadline as a courtesy reminder. • Once updated records are received, the facility is credited for any non- compliant doses/records with the updated record received. • Update audit numbers with new records. • Close audit after deadline, calculate new rate & notify facility of final results. Letter is sent to facility and child-care licensing. Enter data in the electronic Child Health Reporting System (CHRS) and email report to the DSHS representative. If the facility remains non-compliant after the 2nd visit, a corrective action plan is implemented. 2023-2024 Audit Numbers • Licensed Child Care Centers – 49 • Licensed or Registered Family Homes – 17 • Schools – 22 • Private – 12 • Public – 10 • Validation Surveys - 8 Education • The audit team train all Immunizations program staff on children vaccine requirements and record validation. • Austin Public Health Immunizations and the Early Childhood Team collaborate to educate Travis county child care facilities all about audits, vaccine requirements and vaccine records. • Training completed in person, virtual webinars or tabling at events • Educate facilities that are audited Challenges • Lack of education on Immunization requirements and • A Public Health educator for APH Immunizations that Pro-actively educates audits/compliance facilities, schools and the public: 1. How to review and assess immunization records for compliance 2. Education on what constitutes a valid record and immunization exemption forms (conscientious & medical) 3. Advocate and educate on vaccine hesitancy and where to go for vaccines 4. VFC (Vaccines for Children) outreach clinics at schools/childcare centers with high un-vaccinated children. VFC: Medicaid or uninsured children under 19 RESOURCES • CDC Vaccines & Immunizations home page https://www.cdc.gov/vaccines/ • Texas Department of State Health Services (DSHS) https://www.dshs.texas.gov/immunizations • Austin Public Health Department – Immunization Program https://www.austintexas.gov/department/immunizations THANK YOU! Contact information: Edgar Hurtado, Supervisor Ph: 512-972-5510 Email: edgar.hurtado@austintexas.gov